Do you often feel tired even after getting enough sleep? You may wonder if narcolepsy or chronic fatigue syndrome could be the cause. Both conditions can make it hard to stay awake and function normally.

Some of the symptoms of narcolepsy and chronic fatigue syndrome are similar. But they have different underlying causes, diagnoses, and treatments.

Thanks! You've successfully submitted your vote.

Sign up to view the results!

Continue with Facebook

Continue with Google

Continue with your email

By joining, you accept our Terms of Use, and acknowledge our collection, sharing, and use of your data in accordance with our Health Data and Privacy policies.

Already a Member? Log in

Symptoms of Narcolepsy

Narcolepsy and chronic fatigue syndrome, which together are also called myalgic encephalomyelitis (ME/CFS), can cause extreme fatigue. In fact, many ME/CFS symptoms can look like symptoms of other sleep disorders, including narcolepsy.

The symptoms of narcolepsy include:

• Excessive daytime sleepiness — Feeling sleepy during the day even after getting enough sleep at night
• Sudden sleep attacks — Falling asleep suddenly and uncontrollably, even during inappropriate times like while talking, eating, or driving
• Sudden loss of muscle tone — Also called cataplexy, this temporary muscle weakness is often triggered by strong emotions like laughter or anger
• Sleep paralysis — Waking up and being temporarily unable to move or speak, which can be very frightening
• Hallucinations — Experiencing vivid, dreamlike hallucinations when falling asleep or waking up

Narcolepsy usually doesn’t cause direct, serious, long-term health problems. But it can have a big impact on your quality of life and mental health.

Symptoms of Chronic Fatigue Syndrome

The symptoms of chronic fatigue syndrome are different in everyone. Some common symptoms include:

• Fatigue — An overwhelming feeling of tiredness or exhaustion that is not improved with rest
• Post-exertional malaise — Worsening symptoms after periods of mental or physical activity
• Orthostatic intolerance — Feeling dizzy when you go from lying down to sitting up or standing
• Sleep problems — Difficulty falling asleep, staying asleep, or feeling rested after sleep
• Cognitive problems — Trouble thinking clearly, concentrating, and remembering, often described as brain fog
• Flu-like symptoms — Muscle pain, headache, sore throat, and swollen glands (lymph nodes)
• Increased sensitivity — Being more sensitive to lights, sounds, smells, and medicines

Many symptoms of chronic fatigue syndrome can look like symptoms of other sleep disorders, including narcolepsy.

Symptoms of ME/CFS can come and go. They may be mild one day and severe the next.

At times, you may feel better, and at other times, your symptoms may flare up. Symptoms can also change over time, which can make ME/CFS harder to manage.

How Common Are These Conditions?

Estimating the prevalence (how many people in a certain group have a particular condition over a specific time period) of narcolepsy and chronic fatigue syndrome is hard. That’s because it’s difficult to diagnose these conditions. Narcolepsy is a rare disease. Research suggests that about 50 people out of 100,000 have narcolepsy around the world.

The exact causes of narcolepsy and chronic fatigue syndrome are still unclear, but the immune system may be involved in both.

The Centers for Disease Control and Prevention (CDC) estimates that about 1.3 percent of U.S. adults have ME/CFS (roughly 3.3 million adults). Because ME/CFS can be underdiagnosed, the true number may be higher.

Causes

The exact causes of narcolepsy and ME/CFS are still unclear. It’s thought that the immune system may play a role in the development of both narcolepsy and CFS.

The two types of narcolepsy are type 1 and type 2. Although researchers don’t understand as much about why type 2 occurs, they know more about type 1. It’s believed that type 1 narcolepsy is related to low levels of a chemical in the brain called hypocretin (also called orexin). Hypocretin helps you regulate wakefulness and rapid eye movement (REM) sleep.

In people with type 1 narcolepsy, the immune system mistakenly attacks cells in the brain that produce hypocretin. This leads to a shortage of this chemical. The reason that your immune system attacks these cells is unknown. But it’s believed to involve a combination of genetic and environmental factors.

In type 2 narcolepsy, hypocretin levels are usually normal, and people don’t have cataplexy. The cause isn’t well understood. A separate condition, secondary narcolepsy, can happen after certain brain injuries.

The cause of ME/CFS is controversial, but a combination of factors may trigger it. This includes genetics, immune disease, problems with how cells make and use energy, certain viruses or infections, or physical or emotional stress.

Who Gets Narcolepsy or Chronic Fatigue Syndrome?

Although anyone can develop either of these conditions, certain risk factors can make it more likely to be diagnosed with one or the other.

Risk factors for narcolepsy include:

• Age — Symptoms of narcolepsy usually begin in childhood or young adulthood, most often between about 10 and 30.
• Family history — If you’re related to someone with narcolepsy, your risk of narcolepsy might be 20 to 40 times higher.
• Head injury — A head injury that damages the hypothalamus (the area of the brain that controls sleep and wakefulness) may increase the risk of developing narcolepsy.

Risk factors for chronic fatigue syndrome include:

• Female sex — Women are more likely to be diagnosed with chronic fatigue syndrome.
• Age — ME/CFS most commonly affects adolescents between the ages of 10 and 19 and adults between the ages of 40 and 60.
• Family history — You may be more likely to be diagnosed with ME/CFS if you have a relative with the disease.
• Previous infections — Some people develop ME/CFS after recovering from an infection.
• Trauma — Some people develop ME/CFS after experiencing physical or emotional trauma.
• Other medical conditions — ME/CFS is associated with other medical conditions, like fibromyalgia.

Diagnosis

Make an appointment with your primary care physician if you’re experiencing excessive daytime drowsiness or extreme fatigue that affects your daily life. Keep in mind that getting a diagnosis for narcolepsy or ME/CFS can be challenging and takes time.

Make an appointment with your doctor if you’re experiencing excessive daytime drowsiness or extreme fatigue that affects your daily life.

Many of the diagnostic tests for narcolepsy and ME/CFS are the same.

Your doctor may send you to a sleep specialist — a doctor (such as a neurologist, pulmonologist, or psychiatrist) who has extra training in sleep medicine.

The sleep specialist may ask you questions about your sleep history and ask you to record your sleep patterns for a few weeks. If they suspect you have type 1 narcolepsy, they may order a lumbar puncture (spinal tap). This test checks the level of hypocretin in your spinal fluid.

The sleep specialist may also ask you to stay at a medical facility for a sleep study, such as:

• Polysomnography — A test that measures your heart rate, breathing rate, eye movements, leg movements, and brain waves while you sleep overnight
• Multiple sleep latency test — A test that measures how fast you fall asleep during the day by having you take multiple naps

Diagnosis of Chronic Fatigue Syndrome

There’s no specific test for ME/CFS, but your doctor may run blood tests to check for other possible causes of your symptoms. This may include sleep disorders, mental health disorders, or other medical conditions. To diagnose ME/CFS, a healthcare provider must first rule out other causes of fatigue, including narcolepsy.

Other health conditions that may cause fatigue include:

• Anemia (low red blood cells)
• Underactive thyroid
• Diabetes
• Kidney problems
• Liver problems

To be diagnosed with ME/CFS, you must experience moderate or severe symptoms most of the time for at least six months. The United States Institute of Medicine diagnostic criteria include the following symptoms: fatigue, post-exertional malaise, and unrefreshing sleep. You must also experience at least one of the following symptoms: dizziness that gets worse with sitting or standing or cognitive problems.

Treatment

There isn’t a cure for either narcolepsy or CFS. However, medications and lifestyle changes can help improve symptoms.

Narcolepsy Medications

Narcolepsy treatment can include several different types of medications to help relieve symptoms. These include:

• Stimulant medications to help people with narcolepsy stay awake and alert during the day
• Antidepressants to improve sleep, reduce hallucinations, and treat cataplexy
• Sodium oxybate treatments that treat excessive daytime sleepiness and cataplexy

Talk to your doctor about the best treatment for your narcolepsy symptoms and any potential side effects of the medications.

Chronic Fatigue Syndrome Medications

There aren’t any medications made specifically for ME/CFS. Instead, your doctor may suggest options based on your symptoms, such as antidepressants, pain medications, blood pressure drugs, or nutritional supplements.

Talk to your doctor about the best ways to treat your symptoms. If you think you have a vitamin deficiency, ask them for testing before starting any supplements.

Lifestyle Changes

Lifestyle changes can be helpful for both conditions. Some helpful recommendations include:

• Go to sleep and wake up at the same time every day.
• Take short naps during the day, if possible.
• Pace yourself to avoid post-exertional malaise.
• Try gentle movement, and stop if it makes your symptoms worse.
• Avoid alcohol.
• Eat a balanced diet.

Narcolepsy and chronic fatigue syndrome can share symptoms, but they are different conditions. Type 1 narcolepsy is linked to low hypocretin levels, while the cause of chronic fatigue syndrome is still unclear. Treatment for narcolepsy often includes medicines to boost alertness, while chronic fatigue syndrome is often managed by balancing activity and rest and treating symptoms, with your healthcare provider’s help.

Join the Conversation

On MyNarcolepsyTeam, people share their experience with narcolepsy, get advice, and find support from others who understand.

Were you misdiagnosed with chronic fatigue syndrome instead of narcolepsy? Let others know in the comments below.